Article

National trend in prevalence, cost, and discharge disposition after subdural hematoma from 1998-2007

Neuroscience Intensive Care Unit, Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, USA.
Critical care medicine (Impact Factor: 6.15). 03/2011; 39(7):1619-25. DOI: 10.1097/CCM.0b013e3182186ed6
Source: PubMed

ABSTRACT Subdural hematoma is a common type of intracranial hemorrhage, particularly among the elderly, yet, despite the aging U.S. population, little has been published in the last 10 yrs. This study aimed to determine national trends in prevalence, discharge disposition, length of stay, and cost of subdural hematoma over time.
Retrospective cohort study.
Adult patients hospitalized in the United States between 1998 and 2007 identified in the Nationwide Inpatient Sample.
Seven hundred twenty thousand, two hundred ninety-seven adult patients hospitalized in subdural hematoma.
None.
Discharge disposition, hospital length of stay, and national cost (adjusted to 2007 dollars) were examined. Hospitalizations for subdural hematoma increased from 59,373 (30 per 100,000 hospitalizations) in 1998 to 91,935 (42 per 100,000) in 2007, constituting a 39% per-capita increase. The prevalence of subdural hematoma increased with age (p < .001), particularly among those >80 yrs of age (36% of subdural hematoma cohort), in lower income patients, in patients with acquired abnormalities of the coagulation cascade, and in patients with trauma. Inhospital mortality decreased from 15% to 12% (p = .001), but unsatisfactory discharge disposition increased from 17% to 20% (p < .001). National cost increased from $1.0 to $1.6 billion (p < .001). Unsatisfactory discharge disposition and cost were both independently predicted by higher comorbidity index, alcohol abuse, history of trauma, and acquired abnormal coagulation or platelet factors (p < .05). Neurosurgical intervention for subdural hematoma decreased from 41% in 1998 to 31% in 2007 (p < .001). Subdural hematoma evacuation was associated with decreased mortality but did not significantly protect against poor discharge disposition and was associated with significantly higher cost.
The prevalence and total cost for subdural hematoma has increased significantly in the last decade nationwide. Health resource consumption for subdural hematoma is increasing without clear evidence that management practices are leading to improved outcomes.

0 Followers
 · 
113 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The primary objective was to evaluate the associations of the Injury Severity Score (ISS), age, Glasgow Coma Score (GCS), preexisting medical conditions (PEMC), and preinjury activities of daily living (ADL) Katz score with discharge disposition in surviving geriatric trauma patients.Data were obtained from the trauma registry. The preinjury Katz ADL score was prospectively ascertained.Of 184 consecutive surviving geriatric trauma patients with an ISS of 4 to 30, age was 80 ± 8 years and 75% fell. A PEMC was present in 93%. Preinjury ADL limitation occurred in 33%. The Katz score had inverse associations with the number of PEMCs (P< .01) and dementia (P < .01). Preinjury residence was home in 93% and nursing home in 7%. Katz scores by discharge disposition were as follows: home (36%) 5.5 ± 1; nursing home (15%) 3.6 ± 2; rehabilitation (44%) 5.6 ± 1; long-term acute care (5%) 4.0 ± 3 (P < .01). Nursing home/long-term acute care discharge was independently associated (P< .01) withlower Katz score, higher age, and lower discharge GCS; dementia and the number of PEMCs had P > .05. The discharge GCS was associated with the Katz score (P < .01), head injury score (P < .01), dementia (P < .01), and admission GCS (P < .01). The discharge GCS was independently associated (P < .01) with the Katz score and admission GCS. The admission GCS was associated with the Katz score (P = .02), ISS (P < .01), head injury score (P < .01), and dementia (P < .01). The admission GCS was independently associated (P < .05) with the Katz score and ISS.The majority of geriatric trauma survivors with an ISS of 4 to 30 are not discharged home. Lower preinjury ADL function is associated with the lower admission and discharge GCS and greater care needs at discharge. Dementia and the number of PEMCs are not independent predictors of discharge disposition.
    Journal of trauma nursing: the official journal of the Society of Trauma Nurses 01/2015; 22(1):6-13. DOI:10.1097/JTN.0000000000000095
  • [Show abstract] [Hide abstract]
    ABSTRACT: Subdural hematoma (SDH) is a common disease entity treated by neurosurgical intervention. Although the incidence increases in the elderly population, there is a paucity of studies examining their surgical outcomes. To determine the neurological and functional outcomes of patients over 70 years of age undergoing surgical decompression for subdural hematoma. We retrospectively reviewed data on 45 patients above 70 years who underwent craniotomy or burr holes for acute, chronic or mixed subdural hematomas. We analyzed both neurological and functional status before and after surgery. Forty-five patients 70 years of age or older were treated in our department during the study period. There was a significant improvement in the neurological status of patients from admission to follow up as assessed using the Markwalder grading scale (1.98 vs. 1.39; P =0.005), yet no improvement in functional outcome was observed as assessed by Glasgow Outcome Score. Forty-one patients were admitted from home, however only 20 patients (44%) were discharged home, 16 (36%) discharged to nursing home or rehab, 6 (13%) to hospice and 3 (7%) died in the postoperative period. Neurological function improved in patients who were older, had a worse pre-operative neurological status, were on anticoagulation and had chronic or mixed acute and chronic hematoma. However, no improvement in functional status was observed. Surgical management of SDH in patients over 70 years of age provides significant improvement in neurological status, but does not change functional status.
    07/2013; 4(3):250-6. DOI:10.4103/0976-3147.118760
  • [Show abstract] [Hide abstract]
    ABSTRACT: The American population above 65 years of age will double by 2050, and more nonagenarians will present to neurosurgeons for treatment for subdural hematomas (SDH), common in the elderly. Healthcare providers, and patients' relatives, often choose treatment when there is little chance of recovery. Hospital mortality is 24% (n = 5) in chronic subdural hematoma (cSDH) patients over 65 years, but there are no studies on cSDH outcomes in patients aged over 90 years. This retrospective study evaluates outcomes in this population. We reviewed all patients with cSDH between December 2005 and December 2011. We analyzed charts of patients aged 90 years and older. Patient demographics, Glagow Coma Scale (GCS) at presentation, medical co-morbidities, length of stay, disposition, treatment, and radiographic characteristics were abstracted. Twenty-one patients aged 90 or older with 24 admissions for cSDH were identified. Median age was 92 (SD = 2·5); 76% (n = 16) underwent surgery. Median presentation GCS was 14. Disposition to home, rehabilitation facility, nursing home, hospice, or death were not significantly different between conservative and operative groups (P = 0·10), nor was admission GCS (P = 0·59). The size of SDH was significantly (P = 0·02) larger in the operative group. Overall, only 24% (n = 5) of patients were discharged home. Clinical presentation with cSDH is a sentinel event for patients aged 90 years or older; 67% have surgical intervention. Disposition does not vary with surgical or non-surgical treatment. Only 24% of patients of this age group presenting with cSDH return home despite a good admission GCS.
    Neurological Research 04/2013; 35(3):243-6. DOI:10.1179/1743132813Y.0000000163 · 1.45 Impact Factor